Sweet syndrome (acute febrile neutrophilic dermatosis): Management and prognosis
- Joseph F Merola, MD, MMSc, FAAD, FACR
Joseph F Merola, MD, MMSc, FAAD, FACR
- Assistant Professor, Harvard Medical School
- Department of Dermatology
- Department of Medicine, Division of Rheumatology
- Brigham and Women's Hospital
Sweet syndrome (acute febrile neutrophilic dermatosis) is a neutrophilic dermatosis characterized by the abrupt appearance of edematous and erythematous papules, plaques, or nodules on the skin. Fever, leukocytosis, and internal organ involvement can also occur. Sweet syndrome has been associated with infection, malignancy, pregnancy, and drug exposure. (See "Sweet syndrome (acute febrile neutrophilic dermatosis): Pathogenesis, clinical manifestations, and diagnosis".)
Systemic glucocorticoid therapy is a first-line treatment for Sweet syndrome, and usually results in dramatic clinical improvement. Colchicine, dapsone, and potassium iodide are additional effective therapies.
The management and prognosis of Sweet syndrome will be discussed here. Information on the clinical features and diagnosis of Sweet syndrome and an overview of other neutrophilic dermatoses are available separately. (See "Sweet syndrome (acute febrile neutrophilic dermatosis): Pathogenesis, clinical manifestations, and diagnosis" and "Neutrophilic dermatoses".)
APPROACH TO TREATMENT
Although a wide variety of therapeutic interventions have been utilized for Sweet syndrome, there is a paucity of high quality data on the treatment options. Support for the use of therapies for Sweet syndrome is primarily based on case series and individual reports of clinical experience. Systemic therapies, particularly systemic glucocorticoids, are the mainstays of treatment [1-3].
Although spontaneous resolution after weeks to months occurs in an unknown proportion of patients with classical Sweet syndrome, the prominent symptoms and the unpredictable disease course lead us to initiate treatment in most patients. In addition, although our experience indicates that drug-induced Sweet syndrome can improve within several weeks after withdrawal of an offending medication, we have found pharmacologic therapy useful for accelerating clinical improvement in these patients .
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